Law Provides Opportunity to Treat Mentally Ill at Street Level

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First of two parts.

Tuesday, Sept. 6, 2011 | Orange County supervisors will discuss this month whether to make their county the first in California to voluntarily adopt Laura’s Law, a state law aimed at getting severely mentally ill people off the streets.

Supervisors ordered a report on the issue in response to the July beating death of schizophrenic transient Kelly Thomas by Fullerton police. County mental health officials said they wouldn’t discuss the law while they are preparing the report.

Mental health experts, officials in other counties and both advocates and opponents of Laura’s Law say the supervisors will be confronted with an array of issues as they consider implementing the law.

The purpose of Laura’s Law, enacted in 2003, is to provide outpatient medical treatment — mandatory treatment if necessary — for the most severely mentally ill adults in the state. In the most severe cases, untreated patients are homeless and potentially violent.

The law was named for Laura Wilcox, a college student and vacation worker who was murdered by a Nevada County mental patient during the years the bill was making its way through the Legislature. The law gives the courts authority, in the most severe cases, to order an individual to accept specific outpatient treatment.

The Legislature left to each county the decision to implement the law.

Initially the main obstacle was the cost of providing the court-ordered treatment. That obstacle was removed in 2004 when voters approved Proposition 63, which raised money for mental health treatments by imposing a tax on individuals whose annual income exceeds $1 million.

There is also significant opposition on philosophical and political grounds. For three years, opponents battled the plan for involuntary treatment as the bill moved through the Legislature, arguing it was a serious violation of personal rights.

“Usually [elected officials] are reluctant to do anything that’s controversial,” said Bob Stern, president of the Center for Governmental Studies. “They don’t like to make people mad,” particularly if neither side is making substantial campaign contributions.

Added Carla Jacobs of Tustin, who helped write Laura’s Law after dealing with severe mental illness in her family: “There’s always the fear of doing something new or different.”

Tom Anderson, presiding judge of the Nevada County Superior Court and a strong supporter of the law, said it holds county mental health departments accountable for the effectiveness of their outreach programs, something many counties may not want.

But Jacobs and other advocates contend the law is carefully written to protect individual rights and would save the county money from far more expensive hospital and jail costs.

The Question Before the Supervisors

Kelly Thomas was a familiar face on the streets of Fullerton. He was known to be a schizophrenic who did not take medication and had been in trouble with the police before.

Though the vast majority of the outrage following the beating focused on the behavior of Fullerfton police, many have questioned why Thomas, in spite of years of efforts by his family to get him help, was on the streets in the first place.

It will be up to the supervisors to decide whether the potential of Laura’s Law to prevent another Kelly Thomas case outweighs the political risk that the law carries with it.

As they make their decision, the supervisors will have the experience of two other counties to draw upon. Nevada County has fully implemented the law, a requirement of a legal settlement stemming from Wilcox’s murder. Los Angeles County is running a small, modified pilot program.

Los Angeles County health officials focus on a section of Laura’s Law that allows the most seriously ill to voluntarily sign “settlement agreements” to accept treatment.

“I think we’re just starting to see the results,” said Mary Marx, the Department of Mental Health’s district chief. So far, she said, about 17 people have gone through the six-month treatment program, and this month there were three graduates.

“We’re still on a learning curve,” said Marx, but “we’re starting to see more success.”

Michael Heggarty, director of the Nevada County Behavioral Health Department, said although the county has a population of only 100,000, the program, in effect since 2008, has saved $500,000, mostly in reduced jail and hospital costs.

“This isn’t forced treatment,” he said. “This is court-ordered treatment. They [patients] can turn around and walk out the door if they don’t want to do it, and some of them do. It’s not successful with everyone.”

In the early 1970s when California stopped sending most mentally ill adults to hospitals for long-term treatment , it also enacted Section 5150 of the Welfare and Institutions Code, which allows police to send people they consider dangerous to a hospital for 72 hours of mental health treatment and evaluation.

What Laura’s Law does is create specialized outpatient medical treatment plans for adults before a case reaches the point of involuntary treatment. The treatment plan must be approved by the court, and by law the mental health teams must be “highly trained.”

Forced medication is not part of the program. That only can be done in a hospital under a different section of California law.

“But,” said Heggarty, “a majority agree to treatment and show tremendous progress. These folks are not criminals.”

Before an adult can be ordered to seek treatment, the law requires the courts to find “by clear and convincing evidence” that the individual has met all of a series of requirements.

Key conditions include proof that the person’s mental illness has resulted in serious acts of violent behavior toward himself or herself or others; a history of not complying with medical treatment; a history of being hospitalized or jailed for mental illness; and a finding that the person is unlikely to survive without supervision.

The person also must be likely to benefit from the treatment, and his or her mental condition must be shown to be deteriorating.

Jacobs said leaving it to each county to adopt the law is “like passing it in 58 states. Everybody’s got to be educated again.

“I never recognized how hard it is to push a rock up a mountain.”

Tomorrow: The tortured history of Laura’s Law.

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